Case Report
Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 16, 2021; 9(20): 5575-5587
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5575
Table 1 Pre- and post-operative hormone levels and echocardiography
PreoperativePostoperative
Normal range
1-d
3-mo
6-mo
Hormone
Total testosterone (nmol/L)8.42-10.111.770.22-2.9
DHEAS (μg/dL)864.2-149231< 0.19.4-246.0
Cortisol (μg/dL): a.m.-11.8 31.3 3.2 3.7-19.4
Cortisol (μg/dL): p.m.24.1---2.9-17.3
Androstenedione (ng/mL)> 10< 2.11
17-OH progesterone (ng/mL)> 2511.850.2-0.9
Urinary metanephrines (μg/24 h)49.825-312
FT4 (ng/dL)1.131.550.89-1.76
FT3 (pg/mL)2.642.2-5
TSH (μUI/mL)3.460.4-4
Peptide C8.530.9-7.1
Glucagon (ng/L)207< 209
FSH (mIU/mL)< 1021.7-153
LH (mIU/mL)< 1011.3-39.8
PTH (pg/mL)32.4615-63
Echocardiography
Left atrium dimension (cm)45443.0-4.0
Left atrium volume/index (mL/m2)57/3356/3322 ± 6
Left ventricle dimension (cm)60454.2-5.9
Estimated ejection fraction (%)285750-80
Estimated pulmonary artery pressure (mmHg)46209-18
Table 2 Characteristics and evolution of giant adrenocortical carcinoma from case reports in the literature
Ref.
Time until diagnosis
Age (yr)
Sex
Type of tumor
Dimensions
Weight (g)
Metastasis (yes/no)
Ki67 proliferation index
Disease-free interval
Treatment
Functional
Kunieda et al[39], 20004 mo: Weight loss and abdominal discomfort52MFunctional cortisol29 × 19 cm × 10 cm4700Yes (liver and right kidney)NA5 yrSurgery + mitotane 4 g/d, 3 mo
Uruc et al[13], 2015Abdominal pain, flushing48FFunctional sex-hormone secreting23 cm × 18 cm × 16 cm1300Yes (capsular invasion)> 10%NASurgery + mitotane
Bagchi et al[14], 201510 mo: Altered menstrual symptoms; the last 5 mo: Headache, palpitation, anxiety, abdominal pain35FFunctional cushingoid features, pheochromocytoma21 cm × 12 cm × 8 cmNAYes (microvascular invasion lymphovascular)NA1 yr Surgery
Nonfunctional
Zhou et al[40], 20199 mo: No clinical symptoms77MNonfunctional30 cm × 15 cm × 8 cmNAYes (local right- abdominal musculature)> 80%9 moSurgery
Chatzoulis et al[1], 2018Few months: Flatulence and epigastric discomfort39FNonfunctional23.7 cm × 16.5 cm × 11.5 cmNANoNA1.5 yr Surgery
Bacalbasa et al[41], 20153 yr; last months: Abdominal diffuse pain, subocclusion, lower limb edema65MNonfunctional35 cm × 30 cm × 25 cm18500YesNA1 yr Surgery
Stievano Carlos et al[42], 20146 mo: Abdominal pain; last 2 mo: Weight loss49FNonfunctional21 cm2106Yes (hepatic metastases)NA22 mosurgery
Straka et al[30], 201414 d of respiratory distress40MNonfunctional26 cm × 16 cm × 13 cm2372Yes (lymph nodes with invasion to retro-peritoneal structures)NA36 moSurgery
Singh and Gupta[43], 2011Last 2.5 mo: Vague abdominal pain in the left upper quadrant47MNonfunctional22 cm × 18 cm × 15 cm2800Yes (microscopic lymphovascular invasion limited to the capsule and small vessels)NA5 yr Surgery